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Research Methods: Policy Analysis

Erica King, research staff at the Muskie School, co-authored this policy bulletin for the US Department of Justice National Institute of Corrections with Jillian Foley, a recent Muskie School graduate.

Lack of gender-informed policy creates challenges for correctional practitioners. When there is a gap between training that is evidence-based and gender-informed and what is written in policy, staff may find themselves hindered in their attempts to work toward establishing a gender-responsive environment. This policy bulletin, released in February 2015 and based on survey data and focus groups with women, is an initial step to determine the existence of gender-informed policy within correctional agencies. The findings of this bulletin provide an overview of the current state of gender-responsive policies for women and define a focus for future research, training and technical assistance in the effort to create a more effective, and efficient correctional approach for women offenders.

This Issue Brief, authored by researchers at the University of Southern Maine's Muskie School, highlights key lessons learned from the first year of implementation of the MaineCare Health Homes Initiative.

CCTs provide valuable additional support to patients of Health Homes, including home visits and social supports in the community;

Flexibility in program design allowed for wide variation of service delivery models within CCTs;

Three percent of Health Home members were referred to CCTs by the end of the first year, but overall practice referral rates varied by CCT--from 1% to 7% of Health Home members within their associated practices.

This Issue Brief, authored by researchers at the University of Southern Maine's Muskie School, highlights enrollment trends and characteristics of MaineCare's Health Homes initiative during the first year of implementation.

Key Findings:

MaineCare initially estimated 42,000 members were Health Home eligible; 48,000 members were enrolled by December 2013;

Health Homes practices increased referrals to Community Care Team (CCT) services over the course of the first year of the initiative, increasing from 60 members enrolled in CCTs in January 2013 to 1,392 in Decmber (3% of Health Home members);

Health Home members had an average of three chronic conditions. Two out of the five most common conditions were behavioral health related.

Researchers at the Maine Rural Health Research Center Rural have published a review in the January 2015 issue of Current Obesity Reports describing the rural community, home, and individual food environments and what is known about their roles in healthy eating.

Abstract: Rural residents are more likely to be obese and overweight compared to their urban counterparts. Studies of specific rural communities have found that the limited availability of healthy foods in the community and home as well as individual characteristics and preferences contribute to poor diet and overweight. The rural food environment is varied and may be affected by climate, regional and cultural preferences, transportation access, and remoteness among other factors. Given this diversity and the vulnerabilities of rural residents, who are more likely to have low-income, substandard housing or low educational attainment compared to their urban counterparts, policy and programmatic interventions should target specific needs and communities.

The patient-centered medical home (PCMH) model reaffirms traditional primary care values including continuity of care, connection with an identified personal clinician, provision of same day- and after-hours access, and positions providers to participate in accountable care and other financing and delivery system models. However, little is known about the readiness of the over 4,000 Rural Health Clinics (RHCs) to meet the PCMH Recognition standards established by the National Council for Quality Assurance (NCQA). Researchers at the Maine Rural Health Research Center (University of Southern Maine) present findings from a survey of RHCs that examined their capacity to meet the NCQA PCMH requirements, and discuss the implications of the findings for efforts to support RHC capacity development.

Key Findings

Based on their performance on the “must pass” elements and related key factors, Rural Health Clinics (RHCs) are likely to have difficulties gaining National Center for Quality Assurance’s (NCQA) Patient-Centered Medical Home (PCMH) Recognition.

RHCs perform best on standards related to recording demographic information and managing clinical activities, particularly for those using an electronic health record.

RHCs perform less well on improving access to and continuity of services, supporting patient self-management skills and shared decision-making, implementing continuous quality improvement systems, and building practice teams.

Adults with intellectual disability or autism spectrum disorder (ID/ASD) have a variety needs for long term services supports to enable them to live as independently as possible. In Maine, the Office of Aging and Disability Services/Developmental Services provides a wide array of services to adults with ID/ASD, the majority of which are funded through MaineCare. This Chartbook describes Maine’s historical trends in meeting the needs of adults with ID/ASD through institutional and community based services in comparison to other states; a detailed analysis of the population’s utilization of different types of services and their costs in SFY 2010; an analysis of the utilization and cost of services for adults with ID/ASD who were on the waitlists for home and community based waivers services in SFY 2013; the implementation of the Supports Intensity Scale (SIS) as a means of identifying the supports needs of the adults with ID/ASD; and the complement of providers serving this population in Maine.

This Chartbook is unique in its detailing of the service and costs of adults with intellectual disability or austim spectrum disorder (ID/ASD) in Maine. The Chartbook focuses on adults with ID/ASD who are eligible only for MaineCare (Maine's Medicaid system) or who are dually eligible for MaineCare and Medicare.

The Executive Summary provides key findings in the areas of:

Historical Trends

Claims Analysis of Dually Eligible and MainCare-only Eligible Adults with ID/ASD in 2010

As federal and state policymakers consider their most cost-effective options for strengthening rural long-term services and supports (LTSS), more information is needed about the current system of care. Using data from the 2010 National Survey of Residential Care Facilities, this chartbook from the Maine Rural Health Research Center presents information on a slice of the rural LTSS continuum—the rural residential care facility (RCF). Survey results identify important national and regional differences between rural and urban RCFs, focusing on the facility, resident and service characteristics of RCFs and their ability to meet the LTSS needs of residents. Rural RCFs are more likely to have private pay patients compared to urban facilities and their residents have fewer disabilities as measured by their functional assistance needs. Compared to urban facilities, the policies of rural RCFs appear less likely to support aging in place.

Enrollment in high deductible health plans (HDHPs) has increased amid concerns about growing health care costs to patients, employers, and insurers. Prior research indicates that rural individuals are more likely than their urban counterparts to face high out-of-pocket health care costs relative to income, despite coverage through private health insurance, a difference related both to the lower income of rural residents generally and to the quality of the private plans through which they have coverage. Using the 2007-2010 National Health Interview Survey, this study examines rural residents’ enrollment in HDHPs and the implications for evolving Affordable Care Act Health Insurance Marketplaces.

Rural residents with private insurance are more likely to have an HDHP than are urban, especially when they live in remote, rural areas. Among those covered by an HDHP, rural residents are more likely to have low incomes and more limited educational attainment than urban residents, suggesting that it will be important to monitor HDHP enrollment, plan affordability, and health plan literacy among plans available through the Health Insurance Marketplaces.

Enrollment in high deductible health plans (HDHPs) has increased amid concerns about growing health care costs to patients, employers, and insurers. Prior research indicates that rural individuals are more likely than their urban counterparts to face high out-of-pocket health care costs relative to income, despite coverage through private health insurance, a difference related both to the lower income of rural residents generally and to the quality of the private plans through which they have coverage. Using the 2007-2010 National Health Interview Survey, this study examines rural residents’ enrollment in HDHPs and the implications for evolving Affordable Care Act Health Insurance Marketplaces.

Rural residents with private insurance are more likely to have an HDHP than are urban, especially when they live in remote, rural areas. Among those covered by an HDHP, rural residents are more likely to have low incomes and more limited educational attainment than urban residents, suggesting that it will be important to monitor HDHP enrollment, plan affordability, and health plan literacy among plans available through the Health Insurance Marketplaces.

The World Health Organization and Alzheimer’s Disease International have recommended that dementia be considered a public health priority for all nations. The number of people with Alzheimer’s disease in Maine is expected to nearly double from about 26,000 persons in 2010 to nearly 50,000 by 2030. As the oldest state in the nation, Maine faces the impending impact of this disease on its social systems, community resources and its health and long term care systems. In particular, service and use patterns highlighted in this report indicate that Maine’s long term care system is increasingly becoming a system of care for people with dementia.

This report provides a baseline picture of the current use of services by people with and without dementia in Maine. While this provides a comprehensive view of those accessing services through state funded home care programs or other MaineCare funded long term care services, it does not include the costs of informal care by caregivers, friends and family members. Nor does it include the out-of-pocket costs that many incur with private resources to care for a family member. We hope, however, that this information will be useful to those who are planning for the future of Maine’s long term care system and the needs of people with dementia and their families and caregivers.

This report was prepared under a Cooperative Agreement between the Muskie School of Public Service, University of Southern Maine and the Maine Department of Health and Human Services, Office of Aging and Disability Services. This work was funded under Cooperative Agreement number CA-ES-13-251.